1. Field of the Invention
The present invention relates to a patient financial advocacy system and more particularly to a system for identifying potential funding sources for uninsured patients and for the patient portion of healthcare debts that are covered by managed healthcare plans by automating the identification of potential funding sources and automating the collection of data required by such potential funding sources.
2. Description of the Prior Art
Various systems are known for automating the collection of healthcare debts. Such healthcare debts fall into one of two categories, namely debts covered by managed healthcare plans and debts incurred by uninsured patients. Examples of such automated systems for accounts receivable management for debts covered by managed healthcare plans are disclosed in US Patent Application Publication Nos. US 2008/0208640 A1; US 2008/0103826 A1; and US 2008/0189202 A1, hereby incorporated by reference.
Although such automated accounts receivable management systems for managing healthcare receivables that are covered by managed healthcare plans are quite useful, such systems are not useful in managing healthcare debts patients which are not covered by managed healthcare plans and for the patient portion of the healthcare debt. Various methods are known in the art for predicting the payment behavior of various categories of debtors in categories other than health care. Examples of such methods are disclosed in US Patent Application Nos.: US 2003/0212618 A1; US 2005/0197954 A1; US 2006/0287947 A1; US 2007/0208640 A1 and US 2007/0219885 A1, all hereby incorporated by reference. Because of different factors facing the healthcare industry, known payment behavior modeling techniques are generally not applicable to the healthcare industry. For example, healthcare providers, such as a hospital, or other acute or emergency care facility, are required by law to provide certain medical services irrespective of a patient's ability to pay under certain conditions. As such, statistical methods for payment of debtors other than healthcare providers are generally not applicable.
Commonly-owned and co-pending U.S. patent application Ser. No. 12/194,721, filed Aug. 20, 2008, entitled “Healthcare Predictive Payment Method” and US Patent Application Publication Nos. US 2008/0208640 A1 disclose the use of statistical models to predict the patient payment behavior for medical debts not covered by managed healthcare plans. Such systems are only useful for predicting the payment behavior of individual patients. Unfortunately, such systems, as described above, are unable to automatically identify funding sources and collect the necessary data required for patient healthcare debts not covered by managed healthcare plans and for the patient portion of healthcare debts covered by managed healthcare plans.
Various systems have been developed for self-pay healthcare debts. Examples of such systems are disclosed in US Patent Nos.: US 2006/0190334 A1; US 2006/0198336 A1; US 2008/0189202; and US 2009/0299764 A1. None of the systems disclosed in the aforementioned published US patent applications disclose a proactive system that provides automated system for identifying potential funding for healthcare debts of self pay patients, pursuing the funding and measuring the success of such activities as in the Patient Advocacy System. Rather, the patent applications mentioned above relate to reactive systems. More particularly, the '334 and '336 applications relate to a method for automating discounts for self-pay healthcare debts. The '202 system relates to a system for categorizing and auctioning healthcare receivables. Finally, the '764 system relates to a system for creating a healthcare lien network for establishing liens on self-pay healthcare claims which relate to healthcare services for injuries for which a tort or injury claim has been filed.
Thus, there is a need for an automated system for identifying funding sources for healthcare debts in which the patient is responsible and gathering data for various known funding sources, such as Medicaid and Cobra (Consolidated Budget Reconciliation Act of 1985).